Osteomyelitis is an infection and inflammation of the bone or bone marrow that can be caused by a number of different causative organisms. Bone biopsy procedures are the gold standard for the diagnosis of osteomyelitis because the procedures can determine the causative organism causing a particular case of osteomyelitis. Determination of the causative organism is essential for developing a proper treatment plan.
Bone samples can be obtained through either an open biopsy or through an image-guided percutaneous biopsy. The sample taken could be an aspiration of the bone, a core bone sample, or purulent fluid from an abscess. Once retrieved, a common practice is to place the biopsy material in a dry, sterile tube or in a formalin solution. The sample may then be subjected to histological and microbiological examination.
In microbiology, a sample may undergo microscopy, culture, and polymerase chain reaction analysis, among other tests, for the identification of the causative organism. In most cases, the causative organism is not easily determined. A retrospective study with “the largest series of consecutive percutaneous spinal biopsies” found that the success rate of determining the causative organism from culture is about 30%1. Other studies though have found the success rate to be as low as 19%2 or 21%3.
Studies which had unusually high success rates, such as 57% from Rieneck et al.4, or 74% from Lecouvet et al.5, all involved immediate specimen testing without a lengthy transportation period beforehand. In most cases, however, specimens are not tested immediately but are usually held in transit for several hours before being analysed.
Cases in which bone biopsy specimens experience transport for lengthy periods of time tend to result in a lower rate of successful identification of the causative organism behind a case of osteomyelitis.